ABSTRACT
Objectives: To investigate the impact of the COVID-19 pandemic on the drug technology assessment (TA) process of European HTA agencies. This study explored changes to routine practice and assessment in response to the pandemic, and assessed the impact of these changes on the number and type of assessments published during this time. Methods: Adaptations to current assessment practices were established for each HTA agency, including timelines where available. TAs published by the National Institute for Health and Care Excellence (NICE), Scottish Medicines Consortium (SMC), Haute Autorité de Santé (HAS) and Gemeinsame Bundesausschuss (G-BA) during the last 2 years were identified and compared. Results: Initial meeting suspension resulted in the absence of SMC assessments between May and July 2020, with a subsequent phased approach including scope for ‘fast-track to advice’. As part of the phased approach, medicines with the potential to deliver the greatest benefit to patients were prioritised for assessment, although the number of cancer-related assessments remained consistent. NICE published only one assessment per month in March and April 2020, with minimal notable impact on the number of subsequent assessments. Work related to addressing COVID-19 diagnostic or therapeutic interventions and medicines deemed ‘therapeutically critical’ was prioritised, and a higher proportion of assessments pertaining to cancer were published following the emergence of COVID-19. HAS initially assigned priority to drugs intended to manage COVID-19 in addition to new TAs or extension of indication assessments in oncology, paediatrics and in serious illnesses with an unmet medical need;the number of oncology assessments remained consistent following COVID-19 emergence. The reported impact on Germany was minimal;G-BA meetings were held virtually to minimise delays in assessments or pricing negotiations. Conclusions: Despite the individualised approach in response to the challenges of COVID-19, European HTA agencies demonstrated minimal long-term impact and a return to normal drug TA output.
ABSTRACT
Background: Studies show that approx. half of all cancer patients suffer at least temporarily from severe psychological or social distress. However, little is known about the needs and use of psycho-oncological care of cancer patients with a migration background and their relatives, especially regarding people from Asia and Africa, in particular from the Near and Middle East. Hence, we investigate how this group of patients and their relatives deal with their cancer experience and what support needs they express. The project is funded by the German Cancer Aid Foundation. Methods: Qualitative interviews were conducted with cancer patients and relatives who were obtained through office-based oncological practices. The interviews were transcribed and translated into German by native speakers. The collected data was analysed using the qualitative content analysis method. The results were used to develop a questionnaire, which will be distributed in a nationwide quantitative survey in spring/summer 2021. Results: A total of six patients and three relatives were interviewed between January and November 2020. They came from Syria (n=3), Afghanistan (n=2), Pakistan (n=1), Lebanon (n=1) and Turkey (n=2). Recruitment turned out to be difficult, not only due to the current SARS-CoV2-pandemic, but also because patients declined. The only reason provided for non-participation was “no interest”. No further reasons were given. During the interviews, patients told us that they relied on family members for translation, driving them to doctoral appointments as well as taking care of family duties. When asked about thoughts and feelings regarding the diagnosis, they reported that they did not always want to share their feelings with family and friends, partly to protect them from the emotional burden, but also to avoid being pitied. Patients were either open towards psychosocial support, had already experienced it, never heard about this kind of support or were never made aware of the offer by their physician. Conclusions: Our findings provide a first impression about how patients with migration background and their relatives deal with thoughts and feelings after receiving a cancer diagnosis. Reasons why support is sought, and which barriers exist in order to seek help, are very heterogeneous. Further analyses based on the quantitative survey data will show how gender, culture and the current living situation might influence dealing with cancer-related stress and emotions.
ABSTRACT
Introduction: Primary care physicians are essential to cancer care. They frequently identify signs and symptoms leading to a diagnosis of cancer, and provide ongoing support and management of non-cancer health conditions during cancer treatment. Both primary care and cancer care have been greatly affected by the COVID-19 pandemic. In the United States, cancer-related patient encounters and cancer screening decreased over 40% and 80% respectively in January to April 2020 compared to 2019 (London et al. JCO Clin Cancer Inform 2020). However, the impact of the COVID-19 pandemic on primary care access for cancer patients remain unclear. Methods: We undertook a population-based, retrospective cohort study using healthcare databases held at ICES in Ontario, Canada. Patients with a new lymphoid or myeloid malignancy diagnosed within the year prior to the COVID-19 pandemic, between July 1, 2019 and September 30, 2019 (COVID-19 cohort) were compared to patients diagnosed in years unaffected by the COVID-19 pandemic, between July 1, 2018 - September 30, 2018 and July 1, 2017 - September 30, 2017 (pre-pandemic cohort). Both groups were followed for 12 months after initial cancer diagnosis. In the COVID-19 cohort, this allowed for at least 4 months of follow-up data occurring during the COVID-19 pandemic. The primary outcome was number of in-person and virtual visits with a primary care physician. Secondary outcomes of interest included number of in-person and virtual visits with a hematologist, number of visits to the emergency department (ED), and number of unplanned hospitalizations. Outcomes, reported as crude rates per 1000 person-months, were compared between the COVID-19 and pre-pandemic cohorts using Poisson regression modelling. Results: We identified 2882 individuals diagnosed with a new lymphoid or myeloid malignancy during the defined COVID-19 timeframe and compared them to 5997 individuals diagnosed during the defined pre-pandemic timeframe. The crude rate of in-person primary care visits per 1000 person-months significantly decreased from 574.4 [95% CI 568.5 - 580.4] in the pre-pandemic cohort to 402.5 [395.3 - 409.7] in the COVID-19 cohort (p < 0.0001). Telemedicine visits to primary care significantly increased from 5.3 [4.8 - 5.9] to 173.0 [168.4 - 177.8] (p < 0.0001). The rate of combined in-person and telemedicine visits to primary care did not change from 579.8 [573.8 - 585.8] in the pre-pandemic cohort to 575.5 [566.9 - 584.2] in the COVID-19 cohort (p = 0.43). In-person visits to hematologists decreased from 504.1 [498.5 - 509.7] to 432.8 [425.3 - 440.3] (p < 0.0001), and telemedicine visits to hematologists increased from 6.6 [6.0 - 7.3] to 75.9 [72.8 - 79.1] (p < 0.0001). The rate of combined visits to hematologists did not change from 510.7 [505.1 - 516.4] to 508.7 [500.6 - 516.8] (p = 0.68). The rate of ED visits significantly decreased from 95.1 [92.7 - 97.6] in the pre-pandemic cohort to 84.7 [81.4 - 88.0] in the COVID-19 cohort (p < 0.0001). The rate of unplanned hospitalizations did not change from 64.8 [62.8 - 66.8] to 65.7 [62.9 - 68.7] (p = 0.60). Conclusions: Primary care visits for patients with hematologic malignancies did not significantly change during the pandemic, but there was a sizeable shift from in-person to telemedicine visits. Similar findings were seen for visits to hematologists. While the rate of visits to the ED decreased, potentially due to concern of being exposed to the COVID-19 virus, the shift in ambulatory practices did not seem to impact the rate of unplanned hospitalizations. Disclosures: No relevant conflicts of interest to declare.
ABSTRACT
ABS TRACT Objective: This study aimed to evaluate the impact of the coronavirus disease-2019 (COVID-19) pandemic on the follow-up and management of cancer patients. Material and Methods: A survey consisting of 15 questions asking whether there was a delay in follow-up or treatment of cancer during the COVID-19 pandemic was applied to the cancer patients who were admitted to our medical oncology out-patient clinic for follow-up or treatment. Results: A total of 209 cancer patients were included in this study. In 56 (26.8%) patients, there was a delay in the follow-up or treatment of cancer. The delay in cancer treatment occurred in 37 (66%) patients, and the delay in the follow-up of cancer occurred in 19 (34%) patients. The median delay in the follow-up and treatment of cancer was both 30 days (range 1-120) and (range 2-120), respectively. 12.5% of all patients who encountered delays in cancer follow-up or treatment had subsequent cancer-related complications. Also, the delay was significantly higher in quarantined patients and patients diagnosed with severe acute respiratory syndrome-coronavirus-2. In binary logistic regression analysis, living in rural areas and being quarantined due to the COVID-19 pandemic were deter-mined as independent predictors of the delay. Conclusion: The COVID-19 outbreak caused delays in the follow-up and treatment of cancer patients, and acute complications arose due to unavoidable disruptions. To prevent long-term negative consequences of delays in cancer fol-low-up and treatment, it is necessary to adapt the treatments judiciously without sacrificing patient safety and care.
ABSTRACT
Background: The COVID-19 pandemic has dramatically changed lifestyles and quality of life (QoL) of the global population. Little is known regarding the psychological impact of the COVID-19 outbreak on patients with gastroenteropancreatic (GEP) or bronchopulmonary (BP) neuroendocrine tumors (NETs). Methods: We prospectively evaluated seven specific constructs (depression, anxiety, stress, QoL, NET-related QoL, patient-physician relationship, psychological distress) by using validated screening instruments including the Depression anxiety stress scale-21 (DASS-21), the EORTC QLQ-C30, the EORTC QLQ GI.NET21, the patient doctor relationship questionnaire 9 (PDRQ9) and the Impact of event scale-revised (IES-R). Mental symptoms and concerns of patients with any stage, well-differentiated GEP or BP-NET were surveyed twice, during the plateau phase of the first (W1) and second epidemic waves (W2) in Italy. Results: We enrolled 197 patients (98 males) with a median age of 62 years (G1/G2: 96%;pancreas: 29%;small bowel: 25%;active treatment: 38%). At W1, the prevalence of depression, anxiety and stress was 32%, 36% and 26% respectively. The frequency of depression and anxiety increased to 38% and 41% at W2, with no modifications in the frequency of stress. By ordinal logistic regression analysis, female patients showed more severe forms of stress at W1 (OR=0.45±0.14;p=0.01), while the educational status was associated with the levels of anxiety at both W1 (OR=1.33±0.22;p=0.07) and W2 (OR=1.45±0.26;p=0.03). An improvement of the physical (p=0.03) and emotional functioning domains (p=0.001) was observed over time. Both nausea/vomiting (p=0.0002), appetite (p=0.02), treatment related symptoms (p=0.005), disease-related worries (p=0.0006) and sexual function (p=0.02) improved between W1 and W2, suggesting that NET patients were able to cope with the perturbations caused by the pandemic. No difference was seen between W1 and W2 in the mean score (>4/5) of the PDRQ9. By IES-R, post-traumatic stress disorder was observed in 53% of patients at W2. Conclusions: The implementation of psychological interventions within NET clinics might favor the emergence of functional coping strategies, attenuating the psychological distress caused by the COVID-19 pandemic.